Published online before print January 4, 2007, doi: 10.1161/01.STR.0000254718.22566.90
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Stroke. 2007;38:219.)
© 2007 American Heart Association, Inc.
Advances in Stroke 2006 |
Advances in Emerging Therapies 2006
From the Acute Stroke Unit and Cerebrovascular Clinic, Division of Cardiovascular and Medical Sciences, Western Infirmary, Glasgow, UK.
Correspondence to Jesse Dawson, Acute Stroke Unit and Cerebrovascular Clinic, Division of Cardiovascular and Medical Sciences, Western Infirmary, Glasgow G11 6NT, UK. E-mail j.dawson@clinmed.gla.ac.uk
Key Words: antiplatelet • CT perfusion • magnetic resonance imaging • neuroprotection • reperfusion • secondary prevention • thrombolysis
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
The past year has seen further advancement toward the goal of effective and multifaceted stroke treatment. Encouraging evidence has emerged to support mechanical intervention for large artery occlusion, late and imaging-directed thrombolytic therapy, neuroprotectant strategies and decompressive surgery for large middle cerebral artery (MCA) stroke. We have seen important advances with regard to secondary preventative strategies.
The attraction of catheter-based reperfusion techniques is obvious. They may afford use of lower systemic doses of thrombolytic agents, while mechanical clot disruption and retrieval could obviate the need for drugs. This would not only be a particular advantage in those with elevated hemorrhage risk but may also improve the poor reperfusion rates after proximal carotid, basilar or M1 MCA occlusion. Although the MERCI trial1 suggested benefit some 2 years ago, this position has been supported by a recent small series of 12 patients with basilar artery occlusion2 of whom half underwent successful mechanical recanalization. Time to reperfusion was shorter in these patients and they were spared the risks of thrombolytic therapy. Preliminary data also suggest that catheter-based interventions can be applied more distally than hitherto considered possible, perhaps offering direct treatment for intracranial stenosis with reduced rates of stroke or vascular death compared with historical controls.3 Although these techniques are hugely promising and may represent a real alternative for those with major stroke who are unsuitable for recombinant tissue plasminogen activator (rt-PA), we must recognize that conclusive randomized controlled evidence is lacking and benefit is unproven. Furthermore, such techniques will only aid those
Related Articles:
Stroke 2007 38: 395-397.
Stroke 2007 38: 216-218.
Stroke 2007 38: 232-234.
Stroke 2007 38: 222-224.